Liang Yufan, Liang Silin, Huang Jianyang, Hu Linhui, Wu Quanzhong, Li Ziyun, Pan Chixing, He Yuemei, Zhou Xinjuan, Chen Chunbo
Department of Critical Care Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China.
Department of Intensive Care Unit, the Second People's Hospital of Foshan, Foshan, China.
BMC Cardiovasc Disord. 2024 Dec 20;24(1):730. doi: 10.1186/s12872-024-04408-7.
The relationship between the nadir platelet count within the first 48 h after intensive care unit (ICU) admission and the occurrence of acute kidney injury (AKI) in hemorrhagic shock patients remains unclear. This study investigated this association in adult patients admitted to the surgical ICU for hemorrhagic shock.
We included 124 hemorrhagic shock patients, excluding those with pre-existing AKI or chronic kidney disease (CKD), admitted to two affiliated hospitals between January 2019 and May 2022. The nadir platelet count was defined as the lowest value within the first 48 h after ICU admission. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. We used multivariate logistic regression to identify independent risk factors for AKI and analyzed the area under the receiver operating characteristic curve (AUC) for diagnostic accuracy.
Patients with AKI (n = 72) had significantly lower nadir platelet counts compared to those without AKI. The nadir platelet count was identified as an independent risk factor for AKI (OR = 0.988, 95% CI: 0.978-0.999, P = 0.035). The AUC for predicting AKI was 0.862 (95% CI: 0.795-0.929). Combining the nadir platelet count with serum cystatin C levels enhanced the predictive accuracy (AUC = 0.922, 95% CI: 0.870-0.973, P < 0.001).
The nadir platelet count in the first 48 h after ICU admission is independently associated with the risk of AKI in hemorrhagic shock patients and could serve as a potential predictor when combined with serum cystatin C levels.
重症监护病房（ICU）入院后48小时内最低血小板计数与失血性休克患者急性肾损伤（AKI）发生之间的关系尚不清楚。本研究调查了入住外科ICU的失血性休克成年患者中的这种关联。
我们纳入了2019年1月至2022年5月期间在两家附属医院收治的124例失血性休克患者，排除既往有AKI或慢性肾脏病（CKD）的患者。最低血小板计数定义为ICU入院后48小时内的最低值。根据改善全球肾脏病预后组织（KDIGO）标准诊断AKI。我们使用多因素逻辑回归来确定AKI的独立危险因素，并分析诊断准确性的受试者工作特征曲线（AUC）下面积。
与未发生AKI的患者相比，发生AKI的患者（n = 72）最低血小板计数显著更低。最低血小板计数被确定为AKI的独立危险因素（OR = 0.988，95%CI：0.978 - 0.999，P = 0.035）。预测AKI的AUC为0.862（95%CI：0.795 - 0.929）。将最低血小板计数与血清胱抑素C水平相结合可提高预测准确性（AUC = 0.922，95%CI：0.870 - 0.973，P < 0.001）。
ICU入院后48小时内的最低血小板计数与失血性休克患者发生AKI的风险独立相关，与血清胱抑素C水平联合时可作为潜在预测指标。
